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Diabetes mellitus 10. Diabetes: types and causes of their development, course and manifestations, how to treat, possible consequences. What to do if prediabetes is found

Diabetes mellitus is one of the most common, with a tendency to an increase in the incidence and spoiling the statistics of diseases. Symptoms of diabetes do not appear in one day, the process proceeds chronically, with an increase and aggravation of endocrine-metabolic disorders. True, the onset of type I diabetes differs significantly from the early stage of the second.

Among all endocrine pathology, diabetes confidently holds the lead and accounts for more than 60% of all cases. In addition, disappointing statistics show that 1/10 of the "diabetics" are children.

The likelihood of acquiring the disease increases with age and, thus, the size of the group doubles every ten years. This is due to an increase in life expectancy, improved methods of early diagnosis, a decrease in physical activity and an increase in the number of people who are overweight.

Types of diabetes

Many have heard of a disease such as diabetes insipidus. In order for the reader not to confuse the diseases with the name "diabetes" later, it will probably be useful to explain their differences.

Diabetes insipidus

Diabetes insipidus is an endocrine disease that occurs as a result of neuroinfections, inflammatory diseases, tumors, intoxications and is caused by insufficiency and sometimes complete disappearance of ADH-vasopressin (antidiuretic hormone).

This explains the clinical picture of the disease:

Constant dryness of the oral mucosa, incredible thirst (a person can drink up to 50 liters of water in 24 hours, stretching the stomach to a large size);
Excretion of a huge amount of unconcentrated light urine with a low specific gravity (1000-1003);
Catastrophic weight loss, weakness, decreased physical activity, disorders of the digestive system;
A characteristic change in the skin ("parchment" skin);
Atrophy of muscle fibers, muscle weakness;
Development of dehydration syndrome in the absence of fluid intake for more than 4 hours.

The disease in terms of complete cure has an unfavorable prognosis, performance is significantly reduced.

Brief Anatomy and Physiology

Unpaired organ - the pancreas performs a mixed secretory function. Its exogenous part carries out external secretion, producing enzymes involved in the digestion process. The endocrine part, which is entrusted with the mission of internal secretion, is engaged in the production of various hormones, including - insulin and glucagon. They are key in ensuring the consistency of sugar in the human body.

The endocrine gland is represented by the islets of Langerhans, consisting of:

A-cells, which occupy a quarter of the entire space of the islets and are considered the site of glucagon production;
B cells, which occupy up to 60% of the cell population, synthesize and accumulate insulin, the molecule of which is a two-chain polypeptide carrying 51 amino acids in a specific sequence. The sequence of amino acid residues for each representative of the fauna is different, however, with regard to the structural structure of insulins, pigs are the closest to humans, which is why their pancreas is primarily used for the production of insulin on an industrial scale;
D cells producing somatostatin;
Cells that produce other polypeptides.

Thus, the conclusion suggests itself: damage to the pancreas and islets of Langerhans, in particular, is the main mechanism that inhibits the production of insulin and triggers the development of the pathological process.

Types and special forms of the disease

Lack of insulin leads to a violation of the constancy of sugar (3.3 - 5.5 mmol / l) and contributes to the formation of a heterogeneous disease called diabetes mellitus (DM):

The complete absence of insulin (absolute deficiency) forms insulin dependent pathological process, which is attributed to type I diabetes mellitus (IDDM);
Lack of insulin (relative deficiency), triggering in the initial stage a violation of carbohydrate metabolism, slowly but surely leads to the development insulin-independent diabetes mellitus (NIDDM), which is called type II diabetes mellitus.

Due to the violation in the body of glucose utilization, and, consequently, its increase in the blood serum (hyperglycemia), which, in principle, is a manifestation of the disease, signs of diabetes mellitus begin to appear over time, that is, a total disorder of metabolic processes at all levels. Significant changes in the hormonal-metabolic interaction ultimately involve all functional systems of the human body in the pathological process, which once again indicates the systemic nature of the disease. How quickly the disease will develop depends on the degree of insulin deficiency, which as a result determines the types of diabetes.

In addition to diabetes of the first and second types, there are special types of this disease:

Secondary diabetes resulting from acute and chronic inflammation of the pancreas (pancreatitis), malignant neoplasms in the parenchyma of the gland, cirrhosis of the liver. A number of endocrine disorders accompanied by excessive production of insulin antagonists (acromegaly, Cushing's disease, pheochromocytoma, thyroid disease) lead to the development of secondary diabetes mellitus. Many drugs used for a long time have a diabetogenic effect: diuretics, some antihypertensive drugs and hormones, oral contraceptives, etc.;
Diabetes in pregnancy (gestational) due to a kind of mutual influence of the hormones of the mother, child and placenta. The fetal pancreas, which produces its own insulin, begins to inhibit the production of insulin by the maternal gland, as a result of which this special form is formed during pregnancy. However, with proper management, gestational diabetes usually resolves after delivery. Subsequently, in some cases (up to 40%) in women with a similar pregnancy history, this fact may threaten the development of type II diabetes mellitus (within 6-8 years).

Why does "sweet" disease occur?

"Sweet" disease forms a rather "motley" group of patients, so it becomes obvious that IDDM and its non-insulin dependent "brother" genetically occurred differently. There is evidence that insulin-dependent diabetes is associated with the genetic structures of the HLA (major histocompatibility complex) system, in particular, with some genes of the D-region loci. For INZSD, such a relationship was not noticed.

For the development of type I diabetes mellitus, one genetic predisposition is not enough, the pathogenetic mechanism is triggered by provoking factors:

Congenital inferiority of the islets of Langerhans;
Unfavorable influence of the external environment;
Stress, nervous stress;
Traumatic brain injury;
Pregnancy;
Infectious processes of viral origin (flu, "mumps", cytomegalovirus infection, Coxsackie);
The tendency to constantly overeat, leading to excess body fat;
Abuse of confectionery (those with a sweet tooth are at greater risk).

Before elucidating the causes of type II diabetes mellitus, it would be advisable to dwell on a very controversial issue: who suffers more often - men or women?

It has been established that at present the disease in the territory of the Russian Federation is more often formed in women, although even in the 19th century, diabetes was a “privilege” of the male sex. By the way, now in some countries of Southeast Asia the presence of this disease in men is considered predominant.

The predisposing conditions for the development of type II diabetes mellitus include:

Changes in the structural structure of the pancreas as a result of inflammatory processes, as well as the appearance of cysts, tumors, hemorrhages;
Age after 40 years;
Being overweight (the biggest risk factor for NIDDM!)
Vascular diseases caused by atherosclerotic process and arterial hypertension;
In women, pregnancy and childbirth with a high body weight (over 4 kg);
The presence of relatives with diabetes;
Strong psycho-emotional stress (hyperstimulation of the adrenal glands).

The causes of the onset of the disease of different types of diabetes in some cases coincide (stress, obesity, the influence of external factors), but the beginning of the process in diabetes of the first and second types is different, moreover, IDDM is the lot of children and young people, and the non-insulin dependent prefers older people.

Why is it so thirsty?

The characteristic symptoms of diabetes mellitus, regardless of the form and type, can be presented as follows:

Thus, the general signs of diabetes can be characteristic for any form of the disease, however, in order not to confuse the reader, it should still be noted the features inherent in this or that type.

Type I diabetes mellitus - the "privilege" of young people

IDDM is characterized by an acute (weeks or months) onset. Signs of type I diabetes mellitus are pronounced and are manifested by clinical symptoms typical of this disease:

A sharp drop in weight;
Unnatural thirst, a person simply cannot get drunk, although he tries to do it (polydipsia);
A large amount of urine excreted (polyuria);
A significant excess of the concentration of glucose and ketone bodies in the blood serum (ketoacidosis). In the initial stage, when the patient may not yet know about his problems, it is likely that a diabetic (ketoacidotic, hyperglycemic) coma will develop - a condition that is extremely life-threatening, therefore insulin therapy is prescribed as early as possible (as soon as diabetes is suspected).

In most cases, after the use of insulin, metabolic processes are compensated, the body's need for insulin drops sharply, and a temporary "recovery" occurs. However, this short-term state of remission should not relax either the patient or the doctor, since after a certain period of time the disease will again remind of itself. The need for insulin may increase as the duration of the illness increases, but, in general, in the absence of ketoacidosis, it will not exceed 0.8-1.0 U / kg.

Signs indicating the development of late complications of diabetes (retinopathy, nephropathy) may appear in 5-10 years. The main causes of death from IDDM include:

Terminal renal failure, which is a consequence of diabetic glomerulosclerosis;
Cardiovascular disorders, as complications of the underlying disease, which occur somewhat less frequently than renal.

Disease or age-related changes? (type II diabetes)

INZSD develops over many months and even years. Any problems that arise, the person brings to various specialists (dermatologist, gynecologist, neurologist ...). The patient does not even suspect that diseases are different in his opinion: furunculosis, itching, fungal lesions, pain in the lower extremities - signs of type II diabetes mellitus. Often, INZSD is detected by pure chance (annual medical examination) or due to disorders that the patients themselves attribute to age-related changes: “vision has fallen”, “there is something wrong with the kidneys”, “legs do not obey at all”…. Patients get used to their condition, and diabetes mellitus continues to slowly develop, affecting all systems, and first of all - blood vessels, until the person "falls" from a stroke or heart attack.

NIDDM is characterized by a stable, slow course, as a rule, without showing a tendency to ketoacidosis.

Treatment for type 2 diabetes usually begins with a diet that restricts digestible (refined) carbohydrates and uses (if necessary) sugar-lowering drugs. Insulin is prescribed if the development of the disease has reached the stage of severe complications or there is an immunity to oral medications.

The main cause of death in patients with NIDDM is considered to be cardiovascular pathology resulting from diabetes. As a rule, it is or.

Video: 3 early signs of diabetes

Diabetes mellitus treatment

The basis of treatment measures aimed at compensating for diabetes mellitus is represented by three main principles:

Compensation for the lack of insulin;
Regulation of endocrine metabolic disorders;
Prevention of diabetes mellitus, its complications and their timely treatment.

The implementation of these principles is carried out on the basis of 5 main positions:

Diabetes mellitus nutrition is assigned to the part of "first violin";
An adequate and individually tailored exercise system follows the diet;
Sugar-lowering drugs are mainly used to treat type 2 diabetes;
Insulin therapy is prescribed as needed for NIDDM, but is the primary therapy for type 1 diabetes;
Patient education for self-monitoring (finger drawing skills, glucometer use, unaided insulin administration).

The laboratory control over these positions indicates the degree of compensation after carrying out the following:

Indicators	Good compensation	Satisfactory	Bad
Fasting glucose (mmol / L)	4,4 – 6,1	6,2 – 7,8	Ø 7.8
Serum sugar content 2 hours after a meal (mmol / l)	5,5 – 8,0	8,1-10,0	Ø 10.0
Percentage of glycated hemoglobin (HbA1,%)		8,0 – 9,5	Ø 10.0
Serum total cholesterol (mmol / L)		5,2 – 6,5	Ø 6.5
Triglyceride level (mmol / L)		1,7 – 2,2	Ø 2.2

The important role of diet in treating NIDDM

Nutrition for diabetes mellitus is a very well-known, even people far from diabetes mellitus, table number 9. Being in the hospital for any disease, every now and then you can hear about special nutrition, which is always in separate saucepans, differs from other diets and is issued after a certain password has been uttered: "I have the ninth table." What does all this mean? How is this mysterious diet different from all the others?

One should not be mistaken, looking after a diabetic who is taking away his "porridge", that they are deprived of all the joys of life. The diet for diabetes is not so different from the diet of healthy people, patients get the right amount of carbohydrates (60%), fats (24%), proteins (16%).

Nutrition for diabetes mellitus consists in replacing refined sugars in foods with slowly digestible carbohydrates. Shop-for-all sugar and sugar-based confectionery are considered prohibited foods. Meanwhile, the distribution network, in addition to diabetic bread, which we often stumble upon when choosing bakery products, provides such people with sweeteners (fructose), sweets, cookies, waffles and many other sweets that contribute to the production of "happiness hormones" (endorphins).

As for the nutritional balance, everything is strict here: a diabetic must necessarily consume the required amount of vitamins and pectins, which must be at least 40 grams. per day.

Video: a doctor about diabetes nutrition

Strictly individual physical activity

Physical activity for each patient is selected individually by the attending physician, taking into account the following positions:

Age;
Diabetes symptoms;
The severity of the pathological process;
The presence or absence of complications.

The physical activity prescribed by the doctor and performed by the "ward" should promote the "burning" of carbohydrates and fats, without involving insulin. Its dose, which is necessary to compensate for metabolic disturbances, falls noticeably, which should not be forgotten, because, while preventing an increase, you can get an undesirable effect. Adequate physical activity lowers glucose, the injected dose of insulin breaks down the remaining one, and as a result - a decrease in sugar levels below acceptable values (hypoglycemia).

Thus, the dosage of insulin and physical activity requires very close attention and careful calculation, to complement each other, together not to step over the lower limit of normal laboratory parameters.

Video: a complex of gymnastics for diabetes

Or try folk remedies?

Treatment of type 2 diabetes mellitus is often accompanied by the patient's search for folk remedies that can slow down the process and delay the time of taking dosage forms as far as possible. You can understand a person, because no one wants to feel inferior, dooming themselves to dependence on pills or (even worse) from constant injections of insulin.

Despite the fact that our distant ancestors practically did not know about such a disease, folk remedies for the treatment of diabetes mellitus exist, but one should not forget that infusions and decoctions made from various plants are an auxiliary agent. The use of home diabetes medications does not relieve the patient of dieting, blood sugar control, visiting a doctor, and following all of his recommendations.

To combat this pathology at home, fairly well-known folk remedies are used:

White mulberry bark and leaves;
Oat grains and husks;
Walnut partitions;
Bay leaf;
Cinnamon;
Acorns;
Nettle;
Dandelion.

When diet and folk remedies no longer help ...

The so-called first generation drugs, widely known at the end of the last century (bukarban, oranil, butamide, etc.), remained in memories, and they were replaced by new generation drugs (dionyl, maninil, minidiab, glurenorm), which make up 3 main groups diabetes medications produced by the pharmaceutical industry.

What remedy is suitable for this or that patient - the endocrinologist decides, because representatives of each group, in addition to the main indication - diabetes mellitus, have a lot of contraindications and side effects. And so that patients do not self-medicate and do not decide to use these drugs for diabetes at their own discretion, we will give several illustrative examples.

Sulfonylurea derivatives

Currently, second-generation sulfonylurea derivatives are prescribed, acting from 10 hours to a day. Usually, patients take them 2 times a day, half an hour before meals.

These drugs are absolutely contraindicated in the following cases:

In addition, the use of drugs in this group may threaten the development of allergic reactions, manifested by:

Itching and urticaria, sometimes reaching Quincke's edema;
Disorders of the digestive system;
Changes in the blood (a decrease in the level of platelets and leukocytes);
Possible impairment of the functional abilities of the liver (jaundice due to cholestasis).

The biguanide family of sugar-lowering agents

Biguanides (guanidine derivatives) are actively used to treat type 2 diabetes mellitus, often adding sulfonamides to them. They are very rational for use by obese patients, however, for people with liver, kidney and cardiovascular disease, their purpose is sharply limited, switching to more sparing drugs of the same group such as metformin BMS or α-glucoside inhibitors (glucobay), which inhibit absorption carbohydrates in the small intestine.

The use of guanidine derivatives is very limited in other cases, which is associated with some of their "harmful" abilities (accumulation of lactate in tissues, leading to lactic acidosis).

Absolute contraindications to the use of biguanines are:

IDDM (type 1 diabetes mellitus);
Significant weight loss;
Infectious processes, regardless of localization;
Surgical interventions;
Pregnancy, childbirth, lactation period;
Coma;
Hepatic and renal pathology;
Oxygen starvation;
(2-4 degrees) with impaired vision and renal function;
and necrotic processes;
Violation of blood circulation in the lower extremities due to various vascular pathologies.

Insulin treatment

From the above, it becomes obvious that the use of insulin is the main treatment for type 1 diabetes, all emergency conditions and severe complications of diabetes mellitus. NIDDM requires the appointment of this therapy only in cases of insulin-requiring forms, when correction by other means does not give the desired effect.

Modern insulins, called monocompetent insulins, are of two groups:

Monocompetent pharmacological forms of human insulin substance (semi-synthetic or recombinant DNA), which undoubtedly have a significant advantage over porcine preparations. They practically have no contraindications and side effects;
Monocompetent insulins derived from porcine pancreas. These drugs, compared to human insulins, require an increase in the dose of the drug by about 15%.

Diabetes is dangerous with complications

Due to the fact that diabetes is accompanied by damage to many organs and tissues, its manifestations can be found in almost all body systems. Complications of diabetes mellitus are:

Prophylaxis

Measures for the prevention of diabetes mellitus are based on the causes of it. In this case, it is advisable to talk about the prevention of atherosclerosis, including the fight against excess weight, bad habits and food addictions.

Prevention of complications of diabetes mellitus is to prevent the development of pathological conditions arising from diabetes itself. Correction of glucose in blood serum, adherence to a diet, adequate physical activity, following a doctor's recommendation will help to postpone the consequences of this rather formidable disease.

Video: TV program about diabetes

Video: lecture on diabetes

Blood sugar levels are not always constant and may vary depending on age, time of day, diet, physical activity, and stressful situations.

Blood glucose parameters can increase or decrease based on a particular need of the body. This complex system is controlled by the insulin of the pancreas and, to some extent, by adrenaline.

With a lack of insulin in the body, a malfunction occurs, which causes metabolic disorders. After a certain time, an irreversible pathology of internal organs is formed.

To assess the patient's health and prevent the development of complications, it is necessary.

Sugar 5.0 - 6.0

Blood sugar levels in the range of 5.0-6.0 units are considered acceptable. Meanwhile, the doctor may be wary if the tests range from 5.6 to 6.0 mmol / liter, as this may symbolize the development of so-called prediabetes.

Acceptable values in healthy adults can range from 3.89 to 5.83 mmol / liter.
For children, the normal range is from 3.33 to 5.55 mmol / liter.
The age of children is also important to consider: in newborns up to a month, the indicators can be in the range from 2.8 to 4.4 mmol / liter, up to 14 years of age, the data range from 3.3 to 5.6 mmol / liter.
It is important to take into account that these data become higher with age, therefore, for older people from 60 years old, blood sugar levels can be higher than 5.0-6.0 mmol / liter, which is considered normal.
During pregnancy in women, due to hormonal changes, the data may increase. For pregnant women, test results from 3.33 to 6.6 mmol / liter are considered normal.

When tested for glucose in venous blood, the rate is automatically increased by 12 percent. Thus, if the analysis is done from a vein, the data can vary from 3.5 to 6.1 mmol / liter.

Also, the indicators may differ if you take whole blood from a finger, vein or blood plasma. In healthy people, the average plasma concentration is 6.1 mmol / liter.

If a pregnant woman has a fingerstick sample taken on an empty stomach, the average can range from 3.3 to 5.8 mmol / liter. When examining venous blood, indicators can range from 4.0 to 6.1 mmol / liter.

It is important to take into account that in some cases, under the influence of certain factors, sugar may temporarily rise.

Thus, increasing glucose data can be:

Physical labor or training;
Long-term mental work;
Fright, fear, or an acute stressful situation.

Also, in addition to diabetes mellitus, diseases such as:

The presence of pain syndrome and pain shock;
Acute myocardial infarction;
Cerebral stroke;
The presence of burn diseases;
Brain injury;
Surgical operation;
Epileptic seizure;
The presence of liver pathology;
Fractures and trauma.

Some time after the effect of the provoking factor is terminated, the patient's condition returns to normal.

An increase in glucose in the body is often associated not only with the fact that the patient ate a lot of fast carbohydrates, but also with a sharp physical exertion. When muscles are loaded, they need energy.

The glycogen in the muscles is converted to glucose and released into the bloodstream, which causes an increase in blood sugar levels. Further, glucose is used for its intended purpose, and sugar after a while returns to normal.

Sugar 6.1 - 7.0

It is important to understand that in healthy people, capillary blood glucose levels never increase above 6.6 mmol / liter. Since the concentration of glucose in the blood from the finger is higher than that from the vein, venous blood has different indicators - from 4.0 to 6.1 mmol / liter for any type of study.

If the blood sugar data on an empty stomach is above 6.6 mmol / liter, the doctor will usually diagnose that it is a serious metabolic disorder. If you do not make every effort to normalize your health, the patient may develop type 2 diabetes.

With prediabetes, the blood glucose level on an empty stomach is 5.5 to 7.0 mmol / liter, and glycated hemoglobin levels are 5.7 to 6.4 percent. One or two hours after a meal, blood sugar readings range from 7.8 to 11.1 mmol / liter. At least one of the signs is enough to diagnose the disease.

To confirm the diagnosis, the patient will have to:

take a second blood sugar test;
take a glucose tolerance test;
to examine blood for indicators of glycosylated hemoglobin, since this method is considered the most accurate for detecting diabetes mellitus.

The patient's age is also taken into account, since in old age the data from 4.6 to 6.4 mmol / liter are considered the norm.

In general, an increase in blood sugar in pregnant women does not indicate obvious violations, but it will also be a reason to worry about your own health and the health of the unborn child.

If the sugar concentration increases sharply during pregnancy, this may indicate the development of latent latent diabetes. If you get into a risk group, the pregnant woman is registered, after which she is assigned to undergo a blood glucose test and a glucose tolerance stress test.

If the concentration of glucose in the blood of pregnant women is higher than 6.7 mmol / liter, the woman is most likely to have diabetes. For this reason, you should immediately consult a doctor if a woman has symptoms such as:

Feeling of dry mouth;
Constant thirst;
Frequent urination
Constant hunger;
Bad breath;
Formation of a sour metallic taste in the oral cavity;
The appearance of general weakness and frequent fatigue;
Blood pressure rises.

To prevent the onset of gestational diabetes, you need to be monitored regularly by a doctor and take all the necessary tests. It is also important not to forget about a healthy lifestyle, if possible, give up the frequent consumption of foods with a high glycemic index, high in simple carbohydrates and starches.

If all the necessary measures are taken in a timely manner, the pregnancy will pass without problems, a healthy and strong baby will be born.

Sugar 7.1 - 8.0

If the readings in the morning hours on an empty stomach in an adult are 7.0 mmol / liter and higher, the doctor may assert that diabetes mellitus is developing.

In this case, the blood sugar data, regardless of food intake and time, can reach 11.0 mmol / liter and above.

In the case when the data are in the range from 7.0 to 8.0 mmol / liter, while there are no obvious signs of the disease, and the doctor doubts the diagnosis, the patient is assigned a passage.

For this, a blood test is taken from the patient on an empty stomach.
75 grams of pure glucose is diluted with water in a glass, and the resulting solution must be drunk by the patient.
The patient should be at rest for two hours, not eating, drinking, smoking and actively moving. After that, a second blood sugar test is taken from him.

Such a glucose tolerance test is mandatory for pregnant women in the middle of their term. If, according to the results of the analysis, the indicators are from 7.8 to 11.1 mmol / liter, it is considered that the tolerance is impaired, that is, the sensitivity to sugar is increased.

When the analysis shows a result above 11.1 mmol / liter, diabetes mellitus is preliminarily diagnosed.

The risk group for the development of type 2 diabetes mellitus includes:

People who are overweight;
Patients with constant blood pressure of 140/90 mm Hg and above;
People whose blood cholesterol levels are higher than normal;
Women who were diagnosed with gestational diabetes during pregnancy, as well as those whose baby weighed 4.5 kg or more at birth;
Patients with polycystic ovary disease;
People with a hereditary predisposition to the development of diabetes mellitus.

For any risk factor, it is necessary to take a blood sugar test at least once every three years, starting at the age of 45.

Overweight children over the age of 10 should also be regularly tested for sugar.

Sugar 8.1 - 9.0

If three times in a row the sugar test showed overestimated results, the doctor diagnoses type 1 or type 2 diabetes mellitus. If the disease is advanced, high glucose levels will also be found in the urine.

In addition to hypoglycemic drugs, the patient is prescribed a strict therapeutic diet. If it turns out that sugar rises sharply after dinner and these results persist until sleep, you need to reconsider your diet. Most likely, high-carbohydrate meals are consumed, which are contraindicated in diabetes mellitus.

A similar situation can be observed if a person did not eat fully throughout the day, but when he came home in the evening, he pounced on food and ate an excess portion.

In this case, in order to prevent surges in sugar, doctors recommend eating evenly throughout the day in small portions. Fasting should not be allowed, and carbohydrate-rich dishes should be excluded from the evening menu.

Sugar 9.1 - 10

Blood glucose values between 9.0 and 10.0 units are considered a threshold value. With an increase in data above 10 mmol / liter, the kidneys of the diabetic are not able to perceive such a large concentration of glucose. As a result, sugar begins to accumulate in the urine, which causes the development of glucosuria.

Due to the lack of carbohydrates or insulin, the diabetic's body does not receive the necessary amount of energy from glucose, and therefore fat reserves are used instead of the required "fuel". As you know, ketone bodies are substances that are formed as a result of the breakdown of fat cells. When blood glucose reaches 10 units, the kidneys try to excrete excess sugar from the body as waste slag along with urine.

Thus, diabetics, whose blood sugar values are higher than 10 mmol / liter with several blood measurements, need to undergo a urine analysis for the presence of ketone substances in it. For this purpose, special test strips are used, with the help of which the presence of acetone in the urine is determined.

Also, a similar study is carried out if a person, in addition to high data of more than 10 mmol / liter, suddenly felt bad, the body temperature increased, while the patient feels nausea, vomiting is observed. Such symptoms allow timely detection of diabetes mellitus decompensation and prevent diabetic coma.

With a decrease in blood sugar with the help of hypoglycemic drugs, exercise or insulin, the amount of acetone in the urine decreases, the patient's performance and general well-being improves.

Sugar 10.1 - 20

If, with blood sugar levels from 8 to 10 mmol / liter, a mild degree of hyperglycemia is diagnosed, then with an increase in data from 10.1 to 16 mmol / liter, an average degree is determined, above 16-20 mmol / liter - a severe degree of the disease.

This relative classification exists in order to guide doctors when they suspect the presence of hyperglycemia. Moderate and severe degree reports on the decompensation of diabetes mellitus, as a result of which all kinds of complications of a chronic nature are observed.

There are the main symptoms that indicate an elevated blood sugar level from 10 to 20 mmol / liter:

The patient experiences frequent urination, and sugar is found in the urine. Due to the increased concentration of glucose in the urine, linen in the genital area becomes as if starched.
At the same time, due to the large loss of fluid through the urine, the diabetic feels a strong and constant thirst.
There is constant dryness in the mouth, especially at night.
The patient is often lethargic, weak and tired quickly.
The diabetic dramatically loses body weight.
Sometimes a person feels nausea, vomiting, headache, fever.

The reason for this condition is associated with an acute shortage of insulin in the body or the inability of cells to act on insulin in order to utilize sugar.

At this point, the renal threshold is exceeded above 10 mmol / liter, it can reach 20 mmol / liter, glucose is excreted in the urine, which causes frequent urge to urinate.

This condition leads to loss of moisture and dehydration, which is what causes the diabetic's insatiable thirst. Together with the liquid, not only sugar is excreted from the body, but also all kinds of vital elements, such as potassium, sodium, chlorides, as a result, a person feels severe weakness and loses weight.

The higher the blood sugar level, the faster the processes described above proceed.

Blood sugar above 20

With such indicators, the patient feels strong signs of hypoglycemia, which often leads to loss of consciousness. The presence of acetone at a given 20 mmol / liter and above is easiest to detect by smell. This is a clear sign that diabetes is not being compensated and the person is on the brink.

You can identify dangerous disorders in the body using the following symptoms.

When blood sugar is 10 units, then in medical practice this value is considered a threshold value. If there is an increase in indicators above 10 mmol / l, then the patient's kidneys are not able to cope with such a load. As a result, there is an accumulation of sugar in urine (normally this should not be).

Due to the fact that cells cannot perceive glucose, the body of a diabetic cannot receive the necessary energy supply, as a result of which it “gains energy” from fat deposits.

In turn, ketone bodies are those substances that are formed as a result of the breakdown of adipose tissue. When glucose stops at 10 mmol / L, the kidneys work with double duty to get rid of toxins and sugar.

If your blood sugar is 10, what should you do? To answer this question, it is necessary to consider what symptoms are indicative of a hyperglycemic state, and how is high sugar in the body treated?

High levels of glucose in the body

A hyperglycemic state, that is, an increase in blood sugar above the permissible norm, not associated with the use of food, can be observed in a wide range of pathological conditions.

High sugar levels can be a consequence of diabetes mellitus, dysfunction of the pancreas. In addition, this condition is detected with excessive production of growth hormones, with a number of liver pathologies and other ailments.

Diabetes mellitus is a chronic pathology, as a result of which there is a violation of glucose utilization at the cellular level. The most common types of diabetes are type 1 and 2, and they have some distinctive features in the symptoms, respectively, and the therapy will be different.

If blood sugar rises to 10 units, then it appears in urine. Normally, laboratory tests do not detect glucose in the urine. When glucose is observed in it, then the indicators of sugar content are called threshold in medical practice.

And this can be characterized by the following information:

With a sugar of 10 mmol / l, each gram of sugar excreted from the body with the help of urine also removes 15 milliliters of fluid along with it, as a result of which the patient is constantly thirsty.
If you do not replenish the loss of fluid, then dehydration of the body occurs, which can lead to irreversible complications.

Speaking of threshold sugar, it should be noted that each person will have their own numbers. In an adult patient, approximately 30-45 years old, the threshold level will be slightly higher than in a small child, pregnant woman, or elderly person.

Diabetics, regardless of the type of their disease, should know their threshold level, and try with all their might not to exceed it. If this is allowed, then glucose will also be excreted from the body along with urine.

This loss is not restored through the use of food, the cells of the human body will still be "hungry".

The only way to help normalize your well-being is to lower your glucose levels.

Determination of the threshold level

Sugar level

As mentioned above, sugar 10 is a threshold value, and exceeding these indicators threatens serious health problems. That is why every diabetic must know their threshold numbers in order to be able to prevent numerous negative consequences. How do you define them?

The determination is carried out as follows: empty the bladder, measure the sugar in the body. After half an hour, the urine sugar level is measured. Record all data in the table, conduct several studies within 3-5 days.

Upon completion of this, an analysis of their results is carried out. Let's take an example. When sugar is 10-11 units, then its approximate concentration in urine is 1%. Such data indicate that the threshold level has been exceeded.

If the sugar in the body is 10.5 units, and it is not observed in the urine, then the value is below the threshold. When the indicators of glucose in the blood are 10.8 units, while traces of this substance in urine are detected, it means that the threshold level is 10.5-10.8 units.

Analysis by example shows that on average, in the overwhelming majority of cases of clinical pictures of diabetes mellitus, regardless of its type, the threshold level for all patients is approximately 10 units.

Thus, it is necessary to take a number of measures aimed at reducing the concentration of glucose in the body in order to prevent irreversible consequences.

Sugar 10: symptoms

Many patients wonder how to determine an increase in sugar, what symptoms indicate this pathological condition? In fact, measuring sugar is a sure way to help you get the job done.

At home, this will help to implement a special device (glucometer), which will give the correct result of glucose concentration, regardless of the presence or absence of symptoms of an increase in sugar.

Practice shows that not all patients are particularly sensitive to an increase in sugar in their body. Many people do not notice an increase in glucose levels at all until it reaches critical levels.

How severe the symptoms of type 1 or 2 diabetes will be cannot be predicted. However, the symptoms of such an excess should be considered:

The constant desire to drink, and it is almost impossible to tame it. The patient constantly consumes liquid in large quantities, while the thirst symptom does not go away.
Dry mouth, dry skin.
Profuse and frequent urination. The kidneys help the body cope with stress and remove excess sugar through urine.
General malaise, weakness, lethargy and apathy, chronic fatigue, loss of performance, drowsiness.
Decrease or increase in body weight.

Against the background of diabetes mellitus, a decrease in immunity occurs, which in turn leads to frequent infectious and fungal diseases.

High sugar, including at around 10 units, significantly disrupts the work of the whole organism as a whole.

First of all, target organs are affected: the brain, kidneys, eyes, lower limbs.

What to do to lower glucose: general principles

Treatment for diabetes mellitus depends on what type of disease the patient has. And the first type of ailment involves the constant administration of the hormone insulin, which helps glucose to be absorbed at the cellular level.

It should be noted that this therapy is a lifelong event. Unfortunately, despite the development of medical science, in the modern world, diabetes mellitus, regardless of its type, is an incurable disease.

The second type of diabetes mellitus does not depend on insulin, therefore, the following principles of treatment act as its basis:

A wellness diet, in particular eating foods that do not raise blood sugar.
As a rule, type 2 diabetics are obese or overweight, so the second point of therapy is optimal physical activity.
Non-traditional treatment (decoctions and infusions based on medicinal herbs), dietary supplements, and so on.

As for taking medications, they are prescribed if all the measures recommended earlier did not give the required therapeutic effect. It is highly discouraged to prescribe them on your own, it should be done by a doctor.

Despite the fact that insulin is the prerogative of type 1 diabetes mellitus, it can also be prescribed for the treatment of the second type of the disease. Usually it is recommended when no other methods have been able to compensate for the pathology.

The main goal of treating the disease is to achieve good compensation for diabetes mellitus, which in turn makes it possible to reduce the likelihood of complications to zero.

Reducing sugar with food

To lower blood sugar, you need to eat blueberries, which include many tannins and glycosides. It can be eaten fresh, but not more than 200 grams per day.

In addition, a decoction can be prepared based on blueberry leaves to help normalize sugar levels. To prepare it, you need to take one teaspoon of crushed leaves, brew them in 250 ml of liquid. Insist for half an hour. Take 3 times a day for a third of a glass.

Diabetes mellitus is characterized by impaired metabolic processes in the body. Fresh cucumbers will help to restore their full functionality, since they have an insulin-like component. In addition, these vegetables reduce appetite.

The following foods can help lower your sugar levels:

Buckwheat helps to lower glucose levels. To do this, you need to wash the grains, dry them, fry them in a dry frying pan (without oil), grind them into a dusty mixture using a coffee grinder. Recipe: 2 tablespoons per 250 ml of kefir, leave for 10 hours, take once a day before meals.
Jerusalem artichoke helps to normalize the functioning of the gastrointestinal tract, lowers glucose in the body. You can eat several pears (pre-peeled) per day.
Cabbage is enriched with fiber, vitamins and minerals, as well as components that help suppress the development of pathogenic microorganisms. You can squeeze juice from cabbage and drink 100 ml 2 times a day.
It also ensures the normal functioning of the digestive tract, normalizes blood sugar levels. You need to take 120 ml of juice twice a day 30 minutes before meals.
Black radish juice helps to reduce sugar and stabilize it at the required level (take 50 ml up to 5 times a day, it is recommended to drink 15-20 minutes before meals).
Carrot, tomato, pumpkin juice effectively copes with high sugar (no more than 2 glasses per day).

To lower glucose, the body needs zinc, which serves as a catalyst for many biochemical processes in the body. This substance is abundant in seafood (oysters), wheat germ.

An effective remedy for reducing sugar is beet juice, which is taken in 125 ml up to 4 times a day.

The first serious steps towards the creation of an internationally recognized classification of human diseases were made at the beginning of the twentieth century. It was then that the idea of the International Classification of Diseases (abbreviated as ICD) arose, which as of today already has ten revisions. ICD 10 diabetes mellitus codes belong to the fourth class of this classification and are included in blocks E10-E14.

Basic data

The first descriptions of diabetes mellitus that have come down to our time were compiled in the second century BC. But the then doctors had no idea about the mechanism of development of the disease, first identified in the ancient world. The development of endocrinology made it possible to understand the mechanism of the formation of diabetes mellitus.

Modern medicine distinguishes two types of diabetes:

The first type is inherited. Hard to bear. It is insulin dependent.
Type 2 diabetes is acquired during life. In most cases, it develops after forty years. Most often, patients do not need insulin injections.

The division of diabetes into two types occurred in the 1930s. Today, each type has an owl designation in the MBK. Although the development of the eleventh revision of the ICD began in 2012, the classification of the tenth revision, adopted in 1989, is still in force.

All diseases associated with diabetes mellitus and its complications belong to the fourth class of ICD.

This is a list of diseases in blocks E10 through E14. Each type of disease and the complications it causes have their own codes.

According to MBK 10, the code of type 1 diabetes mellitus is E10. After the number ten and the dot, there is one more digit (four-digit codes). For example, E10.4. This code denotes insulin-dependent diabetes that has caused neurological complications. If after ten it is zero, this means that the disease is accompanied by a coma. Each type of complication has its own code, so it can be easily classified.

According to ICD 10, the code of the 2nd type of diabetes mellitus is E11. This code designates the non-insulin dependent form of diabetes acquired during life. As in the previous case, each complication is encoded with its own four-digit number. The modern ICD also provides for the assignment of a code to diseases without complications. So, if insulin-dependent diabetes does not cause complications, it is designated by the code E10.9. The number 9 after the dot indicates no complications.

Other forms included in the classifier

As mentioned earlier, today there are basically two main and most common types of diabetes.

But in 1985, this classification was supplemented by another type of disease common among the inhabitants of tropical countries.

This is diabetes mellitus caused by malnutrition. Most people with this disease are between the ages of ten and fifty. The factor that provokes the appearance of the disease is insufficient consumption of food at an early age (that is, in childhood). In the ICD, this type of disease was assigned the code E12. Like the previous types, depending on the complications, the code can be supplemented.

One of the most common complications among diabetics is diabetic foot syndrome. It can lead to the amputation of the affected limb. In most cases (about ninety percent of diagnosed patients), a similar problem occurs in type 2 diabetics. But it also occurs among insulin-dependent people (that is, suffering from the first type of the disease).

Since this disease is associated with impaired peripheral circulation, it is entered into the ICD under this definition. The ICD 10 diabetic foot symptom code is designated by the fourth character "5". That is, this syndrome in the first type of disease is coded as E10.5, in the second - E11.5.

Thus, as of today, the ICD revision of the 1989 revision remains relevant. It includes all types of diabetes mellitus. It also includes complications caused by this disease. Such a classification system makes it possible to analyze and investigate diseases, having the ability to carry out their systematic registration.

Expert comment:

How and what to treat trophic ulcers of the lower extremities in diabetics

Often in diabetes mellitus, the development of concomitant diseases is observed, which are caused by disorders in the body caused by hyperglycemia. If medical prescriptions are not followed, as well as in conditions of severe diabetes, ulcers can form, mainly on the legs. Diabetic or trophic ulcers are common. Treatment of trophic ulcer wounds on the leg at home with diabetes is almost impossible. The victim requires medical and surgical intervention.

Characteristic

A trophic ulcer involves deep damage to the epithelial layer of the skin and all underlying tissues. Often the disease is accompanied by inflammatory processes that have developed as a result of the addition of a secondary infection.

Sores are oozing wounds characterized by a large diameter of the hole, a large area of damage to the tissues surrounding the ulcer, there is constant bleeding and separation of pus with a characteristic odor.

The disease is coded according to ICD-10, it belongs to chronic skin ulcers, not elsewhere classified, and it is assigned the number L98.4.2.

The reasons for the appearance of a trophic ulcer include:

diabetic neuropathy;
diabetic angiopathy;
mechanical damage to the corns;
destruction of the walls of blood vessels;
pathology of carbohydrate metabolism;
tissue hypoxia, which has arisen against the background of diseases associated with impaired blood flow;
the harmful effects of toxins formed as a result of the breakdown of drugs, the withdrawal of which did not occur due to the peculiarities of the course of diabetes.

Diabetes mellitus is a condition of the body in which there is a constant presence in the blood of a large amount of glucose, due to metabolic disorders. Glucose, when left unbound for a long time, begins to negatively affect nerve endings and blood cells. In the first case, neuropathy develops, in the second - angiopathy. Often, in the absence of proper diabetes treatment, both the first and the second appear at the same time. It is these pathological conditions that are the root causes of disorders that indirectly cause a trophic ulcer.

Wounds on the legs do not form immediately, they are preceded by the initial signs of impaired venous blood flow - heaviness in the legs, cyanosis, edema.

Then eczema, lymphostasis develops, the appearance of the skin of the limb changes and, with minor damage, an ulcer begins to form. First, it destroys the upper layers of the skin and grows in breadth, then the process of destruction of the underlying tissues starts.

Diabetic ulcers are characterized by the following features:

do not heal on their own;
when removed by medication or by surgery, deep scars and scars remain at the site of the wounds;
coldness of the limbs at the initial stages of development due to the death of the nerve endings located in the lower limbs;
pain that bothers the patient mainly at night;
lead to gangrene, and then amputation of the limb in the absence of timely treatment.

Ulcers are divided into types depending on the size of the vessels (capillaries, veins, arteries), the dystrophy of which was the cause of their occurrence.

Initially, the cause of a trophic ulcer is the patient's negligence towards his health and ignorance of the attending physician's prescriptions about a proper lifestyle and nutritional principles. Only long-term high blood sugar levels have this effect.

Treatment

Treatment of diabetic leg ulcers depends on the severity of the disease, but in most cases it is time consuming and laborious.

Therapeutic measures are carried out in 3 stages, which makes it possible to treat the disease not comprehensively, but sequentially, which is more effective in cases of deep tissue damage.

Initial stage

It is important to ensure that the aggravating factors are neutralized and the establishment of a favorable atmosphere for a positive treatment outcome.

adhere to the principles of nutrition for diabetics, monitor blood sugar levels, prevent an increase in it;
to provide the patient with peace and immobility (ulcers located on the soles of the feet are traumatized, as a result of which they heal more slowly);
stabilize sugar levels with medication, if necessary;
identify the cause of the disease and start neutralizing therapy;
restore the activity of the circulatory system.

In addition, it is necessary to apply methods of local therapy:

washing the wound with antiseptic agents;
cleansing the wound from pus, blood, scab;
imposition of wound surfaces;
preventing dirt or foreign objects from entering the wound.

Second phase

After applying all the above measures, the patient's condition should be stabilized. This is reflected in the subsiding of the soreness, as well as in improving the appearance of the wound - it no longer increases in size, the edges become smooth and pink, pus and ichor no longer stand out.

If this happened, then the therapy is my direction and focuses on the use of wound-healing drugs, drugs that contribute to the accelerated regeneration of the skin. It is important to continue to use anti-inflammatory and antiseptic drugs by mouth and topically. In addition, diet therapy must be followed exactly.

If there are signs of infection, the edges of the wound become swollen, pronounced hyperemia of the skin around the ulcer appears, its size increases and itching and burning are added to the pain, this is a sign that trophic ulcers of the lower extremities appeared due to the addition of infection to the original wound.

At this stage, it is necessary to start taking antibiotics and drugs that stabilize and protect the intestinal microflora and mucous membranes (Linex). The drugs will help get rid of the infection, and if the cause is eliminated, the disease will begin to recede.

If necrotic processes have taken place, then surgical intervention is required. It is important to remove dead tissue in time to avoid the onset of gangrene, which, in turn, can lead to amputation.

The final stage and prevention

At the final stage, it is recommended to continue wound healing therapy, take vitamins and immunomodulators to strengthen the body's natural defenses against viral and bacteriological effects. Physiotherapy can be used to restore elasticity and a healthy color to the skin.

To prevent the disease, you need to follow simple tips:

timely diagnose an increase in blood sugar and take measures to reduce its level;
timely subject to the necessary therapy for varicose veins;
limit active physical activity associated with prolonged static stress on the lower extremities;
prevent hypothermia or overheating of the lower extremities, the temperature drop will provoke the onset of destructive processes in fragile vessels;
prevent the formation of microtrauma or minor abrasions on the surface of the skin on the legs, due to the fact that they can become the first stage in the development of a trophic ulcer;
use orthopedic shoes to ensure the normalization of blood flow in the lower extremities.

With severe hyperglycemia, it is extremely important to monitor your health and follow all the recommendations of an endocrinologist. Such a serious consequence as a trophic ulcer becomes a signal that the form of the course of the disease has become more complex and profound. The attending physician will also tell you how and how to treat a trophic ulcer in diabetes mellitus. Self-treatment of this disease is not allowed, due to the increased risk of developing gangrene. Folk remedies are not prohibited for use, but only in combination with drug therapy.

Blood sugar 10, what does it mean? This indicator indicates an increased level of glucose dissolved in the blood. There are many ways that you can lower the indicator. To find out your blood sugar level, you should donate blood for a test early in the morning before or after a meal. Older people should do this analysis about 3 times a year. When diabetes is detected, a home device is used to measure the indicator on a daily basis: it is convenient and inexpensive.

Increased sugar

Elevated plasma sugar is called hyperglycemia. An increased indicator may be the norm, but it will be just an adaptive action of the body to restore energy metabolism.

Glucose consumption increases:

fear;

excitement;

severe pain.

Diseases of the endocrine system with an increase in glucose provoke an increase in the release of sugar into the internal environment of the body, which it does not have time to process into energy.

With hyperglycemia, metabolism is impaired, therefore:

The functioning of the immune system is reduced.
There are abscesses and dysfunctions of the genitals, innervation.
Usually the consequences are expressed in the defeat of the pancreas and the presence of sugar in the urine.
Also, high sugar can cause metabolic disorders and the release of toxic metabolic products, which will negatively affect the body.

Mild hyperglycemia has almost no negative effect on the body, but if the sugar is very high, then the person suffers from thirst and drinks a lot of fluids, as a result of which there is a frequent urge to urinate. In this case, the body removes sugar along with urine, and the mucous membranes become too dry.

At an extreme degree of the disease appear:

Nausea with vomiting.
Drowsiness.
General weakness.
Sometimes loss of consciousness occurs, which is a sign of hyperglycemic coma, which in some cases ends in death.

Blood for research must be taken on an empty stomach. When the indicator rises above 5.5 mmol / l, the doctor diagnoses hyperglycemia.

The main symptoms of the disease are:

thirst;
dry mouth;
frequent urination;
dry skin;
vision as in a fog;
a state of constant fatigue and drowsiness;
losing weight for no apparent reason;
poor wound regeneration;
tingling in the legs;
diseases of an infectious and fungal nature that do not respond well to therapy;
rapid breathing;
the smell of acetone from the mouth;
emotional instability.

How to determine the indicator, what is the norm in a person's blood?

To determine your glucose level, you need to take a fasting blood test.

This method has certain disadvantages:

With the help of such a study, you can determine the glucose level only at the moment. Rates may vary from week to week.
The road to the clinic, especially on foot, can cause a decrease in the indicator. This is because fresh air lowers blood sugar. The water drunk in the morning before leaving the house has the same effect: it dilutes the sugar.
The indicator may have been increased for a long time, but casual physical activity may lower it, and the result of the study will turn out to be incorrect.

The norm of sugar in a healthy person is in the range from 3.3 to 5.5 mmol / l. An increase in sugar occurs when glucose obtained with food is not completely absorbed. Also, diabetes can be insulin-dependent, that is, the pancreas does not produce enough insulin (type 1). The second type is characterized by the malfunctioning of insulin.

A sufficiently long increase in the indicator leads to serious complications. One of them is blood thickening due to excess glucose. This makes it difficult for blood to pass through the capillaries and can lead to thrombosis.

A sick person has a fairly large range of indicators: from 4 to 10 mmol / l. It is rarely possible to approach the normal indicator, but the above boundaries are a kind of norm for diabetics. With such limits, a person will be able to protect himself from various complications for about 10 years. To constantly monitor your blood sugar level, you need to buy a glucometer and take measurements daily.

To reduce the indicator, you should combine several methods. First of all, you must strictly follow all the doctor's prescriptions and build your own diet correctly. A properly formulated daily diet can lower blood sugar levels and keep them in this state for a long time.

Diet

What to do if glucose is high? High glucose is a reason to see a qualified doctor. Sometimes diabetes is not accompanied by specific symptoms, but it is still better to get specific recommendations. It is especially important to adjust your diet to reduce carbohydrate processing.

An overweight person requires a low calorie diet that includes many foods that contain vitamins, minerals and other important trace elements. The daily menu implies the intake of both proteins and fats with carbohydrates. Carbohydrates eaten must be broken down slowly. In the table of the glycemic index, such carbohydrates should be in the last positions.

When compiling a healthy diet, it is necessary to pay great attention to the frequency of meals and their portions:

The food supply should be large enough in total throughout the day, but it should be supplied in small portions.
Breaks between meals should be taken for about three hours.
It is best to have about 6 meals a day: snacks and main meals. This means that you can not indulge in snacks, chips, fast food and soda.
It is very healthy to eat fruit.

The amount of calories consumed will depend on the constitution of the person and the degree of his physical activity. The diet should include the use of vegetables, protein foods and fruits. It is also important to drink enough fluids to lower blood sugar levels.

With high sugar, you must abandon the following foods:

pure sugar;
carbonated drinks;
flour and other confectionery products;
fatty;
smoked;
alcohol;
grapes with figs and raisins;
butter and sour cream with cream.

It is imperative to eat boiled and stewed, baked and steamed. At the same time, ready meals should contain a minimum amount of salt and vegetable fats. You need to eat 2 hours before bedtime. It is recommended to drink water and tea, black coffee without sugar and herbal infusions with fresh pomace juices.

First of all, if you find high sugar, you should visit a specialist. He will help you adjust your diet, prescribe all the necessary studies and tell you how to avoid this in the future. At the same time, it is important to monitor your glucose level yourself at home so as not to provoke unpleasant complications that can interfere with your daily life.